Abstract
Periodontitis is an inflammatory disorder that results in tissue destruction when there are too many germs present or when the host’s normal inflammatory response is disrupted. The fight against periodontal regeneration is a titanic one. Tissue engineering was suggested by Langer and colleagues as a potential method for replacing the missing periodontal tissues. The development of functional and long-lasting periodontal tissues will take the role of sick tissues thanks to the science of tissue engineering, which combines engineering and the life sciences.
Tissue engineering is an emerging specialisation in the realm of medical health and sciences. It is advancing, spreading its wings over numerous facets of molecular biology, physiology, surgery, regeneration, and molecular medicine. Cell biologists, molecular biologists, biomaterial engineers, experts in microscopic imaging, robotics engineers, computer-assisted designers, and developers of equipment such as bioreactors, where tissues are grown and nurtured, are just a few of the medical and technical specialties that make up the field. Finally, legal advisors and marketing research specialists (product development, and medical implementation) are also involved in the practical process of tissue engineering. New biological organs will be created in the future using engineering and biological techniques.
Introduction
The periodontium is a sophisticated organ made up of soft, mineralized connective tissue and epithelium tissue. The periodontium is made up of the gingiva, periodontal ligament, cementum, and alveolar bone. The deterioration of the connective tissue matrix and cells, the loss of the fibrous connection, and the resorption of alveolar bone are all caused by diseases that impact the composition and integrity of periodontal structures.
An inflammatory periodontal disease is periodontitis. It is one of the most prevalent forms of periodontal disease and is linked to dental plaque on the surface of the tooth root. Periodontitis develops as a result of an excessive amount of bacteria present or a changed inflammatory response of the host to germs (individual susceptibility). If the damaging process is not stopped, it causes the tissues to wear down and bone resorption, which eventually causes tooth mobility and tooth loss. Although it needs the presence of enough bone tissue, using dental implants to replace lost dental components when teeth are beyond saving is a safe and successful treatment. Implant osseointegration is the crucial phase that needs to be prioritised. Many studies have been conducted to improve the implant-bone contact, which affects the surface characteristics of implants by lowering their sensitivity to bacterial colonisation and increasing their roughness [1–3].
Damaged periodontium can regenerate, but only to a limited degree. The periodontal treatment’s empyrean goal is to stop additional attachment loss and restore the supporting tissues. A functional epithelial seal, the insertion of new connective tissue into the root surface, and the restoration of alveolar bone height are only a few of the criteria for a successful periodontal regeneration [4].
The ultimate goal of periodontal therapy is to restore the physiological anatomy and function, in the best way possible. The Guided Tissue Membrane (GTR) approach has traditionally been recommended for regeneration. The application of numerous growth factors to the root surface as well as the use of bone and enamel matrix proteins have all been recommended in recent years. The use of growth factors has been known to stimulate the repopulation of the defect with appropriate endogenous progenitor cells in order to induce regeneration, but this therapeutic approach does not allow controlling the spatiotemporal distribution and activity of these proteins. The application of growth factors into the defect has demonstrated encouraging effects on periodontal regeneration. To get over the aforementioned restriction, highly segregated scaffolds have been suggested for gene therapy and the transport of chemicals. Understanding of the prerequisites for efficient periodontal regeneration, notably the necessity to regulate and coordinate both cellular and molecular processes, has improved over the past several years as a result of scientific advancement [9–11]. With the emerging advances in tissue engineering in the field of periodontology, we will be able to restore the anatomy, physiology and functions of the periodontium.
Clinical applications of tissue engineering for periodontal tissue engineering
Guided tissue engineering
Nyman and Karring (1982) were the first ones to have proposed the use of directed tissue regeneration for periodontal regeneration, which signalled the emergence of periodontal regeneration technologies employing tissue engineering. The application of barrier membranes across the denuded root surface and the debrided periodontal defect has shown space provision, epithelial cell occlusion, and exclusion of gingival connective tissue from the root surface and selective repopulation of periodontal ligament cells. Numerous studies showing the therapeutic advantages of employing Guided Tissue Regeneration (GTR) Membrane alone or in conjunction with other regenerative components [12].
Protein-based strategies
The most widely used tissue engineering technique for the regeneration of periodontal tissues is the use of growth and differentiation factors, which took tissue engineering to the next level. Several growth factors have been used includes transforming growth factor β, Bone morphogenetic proteins (super family members), Basic fibroblast growth factor and Platelet derived growth factor.
Enamel matrix derivative
The finding that enamel matrix proteins are deposited onto the surfaces of growing tooth roots prior to cementum production provides the justification for the clinical usage of enamel matrix derivatives [13]. Emdogain, a commercially available form of enamel matrix protein (EMPs), has been shown to promote periodontal regeneration. It has been shown that the use of an enamel matrix derivative (EMD) and a demineralized freeze- dried bone allograft (DFDBA) has osteopromotive properties, leading to an extra rise in bone production [14].
Therapeutic uses of recombinant proteins
As recombinant technology develops, commercial applications are observed. The combination of pure recombinant human growth factor and matrix has been created and is sold on the market. Today, enormous quantities of sterile proteins are generated, concentrated, purified, and packed under strictly controlled and regulated circumstances. In order to improve the predictability of regenerative operations, growth regulating chemicals must be provided in highly concentrated pure and matrices. Additionally, this enables researchers to create enhanced regenerative products that combine the physical and chemical properties of tissue-specific matrices necessary for specific cell attachment, growth, and differentiation, with the ideal binding and release profile for these bioactive proteins that actively draw healing cells to the treatment site and increase their cell numbers in order to achieve the greatest regeneration [12]. Only three recombinant growth factor products— rh PDGF-BB (gel) [15], rhPDGF-BB (with tricalcium phosphate) [16], and rh BMP-2 (with type collagen sponge)— have received widespread use [17]. Recombinant platelet derived growth factor (rh PDGF BB) is a more than 98% pure recombinant protein created under strictly regulated circumstances utilising traditional recombinant expression procedures [18]. The FDA has approved the use of rh PDGF, one of the choices for regenerating the periodontium. The idea of using therapeutic recombinant proteins given in an allograft matrix has produced important clinical outcomes. Recently, Nevins and colleagues reported on the effectiveness of biomimetic medicines called GEM 21 S (growth enhanced matrix TCP+PDGF) [19].
Simion M. (2009) did a study using an organic bone block and rh PDGF to increase the vertical ridge. Better healing and more bone regeneration were the results [20].
Drawbacks
Scaffold building is challenging, time-consuming, and expensive. A lot of individuals disagree with tissue engineering because they think that life begins at conception and using artificial organs to save someone’s life goes against the laws of nature. Given the state of technology today, introducing such products to the market is challenging.
Summary
By creating the right conditions to enhance the natural healing capacity of tissues, advancements in tissue engineering have made it possible to restore injured tissues and organs. The use of tissue engineering was suggested to offer promising opportunities for developing novel strategies for periodontal regeneration, taking into consideration the former, to overcome the limitations of conventional periodontal regenerative treatment approaches and to develop a more reliable and predictable periodontal regeneration [21]. Millions of patients could profit greatly from the ongoing development of tissue engineering techniques for the regeneration of dental tissues, which has the potential to significantly alter clinical treatment plans.
Conflict of interest
The authors have no conflict of interest to report.